Low coronary flow reserve in patients with long-standing persistent atrial fibrillation is associated with worse clinical outcomes

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background / Introduction Atrial fibrillation (AF) is associated with an increased risk of myocardial infarction, stroke and all-cause mortality. Myocardial perfusion imaging (MPI) is well-established for the diagnosis of coronary artery disease (CAD) and risk-stratification in sinus rhythm (SR) patients. Purpose The aim of this study was to determine the prognostic impact of AF and coronary flow reserve (CFR) in patients undergoing positron emission tomography (PET) MPI. Methods 680 patients without a known history of CAD were included. 226 paroxysmal AF (PAF) and 114 long-standing persistent AF (LSPAF) patients were identified from a prospective PET MPI registry in the Isala Hospital and propensity matched in a 1:1 ratio to SR patients. The main indications for PET MPI were chest pain and dyspnea. Follow-up was obtained for the occurrence of major adverse cardiac and cerebrovascular events (MACCE, composite of myocardial infarction (MI), stroke/transient ischemic attack (TIA) or all-cause death). Results Compared with patients with PAF, patients with LSPAF were older (p=0.011) and more frequently male (p=0.031), with no significant differences in medical history. There were no significant differences between SR and AF in the occurrence of MACCE during a mean follow-up of 36 months. However, the incidence of downstream coronary angiography (p<0.001) and MACCE (p=0.028) was higher in patients with LSPAF compared to those with PAF and SR. A low CFR (defined as CFR below the median of 2.4) in patients with LSPAF showed significantly more MACCE compared with SR and PAF (p<0.001). Moreover, LSPAF was an independent predictor of MACCE (odds ratio 1.667, 95% confidence interval 1.028±2.705). Conclusion Low CFR in patients with LSPAF is associated with a higher incidence of MI, stroke/TIA and death compared with low and normal coronary flow parameters in patients with SR and PAF.